Tech challenge seeks to improve care transitions

 Posted by on September 25, 2011  No Responses »  Tagged with: , ,
Sep 252011
 

A technology challenge is looking for innovative ways to improve the quality of care transitions, reduce preventable hospital readmissions, and improve patient safety. Tech challenges are a popular tool in the technology community to encourage innovative development among software developers. In this case, the first prize is $25,000 (plus tons of free publicity) for the winning developer. Software developers have until November 16, 2011, to sign up for the challenge. I am one of the judges for the competition, and I hope we will have lots of useful applications to evaluate. For full details, visit the competition website, ”Ensuring Safe Transitions from Hospital to Home Challenge”, at http://legacy.health2con.com/devchallenge/files/iBlueBotton-Slides.pdf.

This tech challenge is sponsored by the Office of the National Coordinator for Health Information Technology (ONC-HIT) in collaboration with the Partnership for Patients. The Partnership for Patients is a new nationwide public-private partnership launched by Secretary of Health and Human Services Kathleen Sebelius to tackle all forms of harm to patients. Its aims include a 20% reduction in readmissions over a three year period and a 40% reduction in preventable hospital-acquired conditions.

Nearly one in five patients discharged from a hospital will be readmitted within 30 days. A large proportion of readmissions can be prevented by improving communications and coordinating care before and after discharge. The Centers for Medicare and Medicaid Services (CMS) provides a discharge checklist to help patients and their caregivers prepare to leave a hospital, nursing home, or other care setting. Research has shown that empowering patients and caregivers with information and tools to manage the next steps in their care more confidently is a very effective way to reduce errors, decrease complications, and prevent a return visit to the hospital.

The ideal application for this tech challenge will:

  • Incorporate the content of the CMS Discharge Checklist
  • Help patients and caregivers access the information and materials needed to answer the checklist’s questions about their condition, their medications and medical equipment, and their post-discharge plans
  • Share this information with doctors, pharmacists, nurses and other professionals in their next care setting (e.g., home, nursing home, hospice)
  • Identify community-based organizations or others who can provide valuable assistance
  • Leverage and extend NwHIN standards and services including, but not limited to, transport (Direct, web services), content (Transitions of Care, CCD/CCR), and standardized vocabularies
Print Friendly, PDF & Email
twitterrssyoutube

Building the Will for Change: A Video from Dr. Joanne Lynn

 Posted by on September 19, 2011  No Responses »  Tagged with: , ,
Sep 192011
 

What kinds of changes are needed to improve care transitions, and thereby improve patient care and experience? It is a complex issue, and requires hard work. Building the will to face and fix these problems is essential to creating a better health care system. Dr. Joanne Lynn describes how individuals and organizations can get motivated—and get started.

Print Friendly, PDF & Email
twitterrssyoutube

Why Improve Care Transitions: A Video from Dr. Joanne Lynn

 Posted by on September 12, 2011  No Responses »  Tagged with: , , ,
Sep 122011
 

Transitions between care settings are fraught with errors that can lead to unnecessary suffering for patients and families, frustration for clinicians, and avoidable expenses for providers. Organizations nationwide need to pull together to create a seamless care system for patients living with multiple chronic conditions. Dr. Joanne Lynn explains why the issue of care transitions is paramount in endeavors to improve care of frail elders, and others living with advanced chronic conditions. This is the first of a 12-part video “how-to” series in which Dr. Lynn provides an overview of the issues, describes quality improvement efforts underway, and gives tips for clinicians and communities ready to get started in their own settings.

Key words: care transitions, frail elders, quality improvement, Joanne Lynn

Print Friendly, PDF & Email
twitterrssyoutube

Care Transitions and Altarum Institute Center for Elder Care and Advanced Illness

 Posted by on September 8, 2011  No Responses »  Tagged with:
Sep 082011
 

Meet Dr. Joanne Lynn as she describes work being done by the Altarum Institute Center for Elder Care and Advanced Illness to improve care transitions. This is the introduction to a 12-part series that will be released over the next several weeks. Stay tuned for more, with information on why it’s important to address care transitions, how to get started, and where to find ideas, resources, and guidance.

 

 

 

Print Friendly, PDF & Email
twitterrssyoutube

Can Care Transitions Be Improved by Focusing on a Single Diagnostic Category?

 Posted by on September 6, 2011  1 Response »  Tagged with: ,
Sep 062011
 

 by Dr. Joanne Lynn

 A colleague asks if it makes sense, when engaging in care transitions work, to begin with a disease focus, specifically in congestive heart failure. Innovators do need to start their efforts somewhere, and doing so in areas in which there is a strong will and the perception of a workable plan seems reasonable. Heart failure often meets those criteria, and lots of teams have started there. Even so, it is important not to stay within those boundaries for too long—that’s harder to do, but essential to improving the larger system.

For any diagnostic category, serving a patient in one bed with a better transitions process than the patient in the next bed is (and should be) quite disorienting to the staff.  If the better services are perceived as an “add on” for which only some are eligible (as in a grant program or a research project), then the informal message is that the less-good approach is perfectly fine.  This makes it hard to generate the outrage that is appropriate in creating intolerance to hopelessly inadequate patterns of care (for all).  Thus, one can get away with saying something such as, “This situation is terrible for all, we must change it, we are going to start with CHF and learn enough to make it better for all fairly quickly.”  But one really diminishes the odds of success if the message is, “This situation is OK, but could be better, perhaps, and we are going to set out to see if we can make it better for the populations that CMS measures, starting with CHF.”

Also noteworthy is the imprecision in the CHF diagnostic category; especially in older patients, CHF is an indistinct diagnosis that says little more than “not doing well.”  When one applies treatments that were developed on cleanly diagnosed (and mostly younger and less frail) patients, one can actually cause great harm.  If one takes an elderly person who is labeled as CHF but who really has venous insufficiency and puts that person on a carefully controlled weight monitoring system, you can readily induce dehydration.  And all the data on CHF were developed for patients diagnosed with CHF only.  The typical complex patient with CHF as part of a complex frailty pattern presents many more challenges. 

 As improvement teams face the issues of complex diagnoses, or multiple diagnoses, they begin to realize that the CHF patient in one bed is not very different from the person in the next bed who does not have a CHF diagnosis, but has all the same complexities of clinical and social needs (e.g., family support, living arrangements, medication adherence, skin breakdown, risk of falling, and so on).

 So, I’d encourage you to bow to the need to get started–but still to try hard to have teams recognize that they need to be more inclusive in their goals and that they need to get on to those goals in a reasonable time.  Working with CHF is “a test” and not the whole project.  Some, for reasons of leadership commitment, have not done that and have stayed with CHF, or with some other particular diagnosis, such as CHF/Pneu/AMI (chronic heart failure, pneumonia, and acute myocardial infarction, the three that Medicare currently reports on Hospital Compare), and that more narrow approach appears to have hamstrung their progress.

 

 Keywords: congestive heart failure, quality improvement, care transitions, system improvement

Print Friendly, PDF & Email
twitterrssyoutube

Learning from Reviewing Readmissions: Tools You Can Use

 Posted by on August 8, 2011  No Responses »  Tagged with: , , , , , , ,
Aug 082011
 

A colleague asked an important question: Which tools are best for reviewing causes of readmissions? Two examples, from Georgia and New Jersey, are attached to this posting. Georgia’s form requires starting from a patient/family interview review, and does not pull much from the record of the hospitalization. New Jersey’s form starts from the other direction – all pulled from charts, with just the contact information that enables an interview if someone undertakes it.  Each has targeted a certain set of issues — clear plan, medications, teach-back, advance directives, social problems, and so on.  Although the two forms overlap on many targets, on others they do not.

NJ_Readmission Chart Review tool

NEW_GA ReadmissionWorksheet

The Institute for Healthcare Improvement (IHI) has developed another useful form, which can be found on page 88 at this URL: http://www.ihi.org/knowledge/Pages/Tools/HowtoGuideImprovingTransitionstoReduceAvoidableRehospitalizations.aspx.  It “feels” more succinct, because it is set up to do 5 readmissions at a time and to focus upon themes.  But it also requires a more insightful reviewer, one who has thought about what it is that makes for rapid readmissions and what might work to make transitions bette

One way to get started is to simply review just a few charts of people who were readmitted to the hospital with which you are most familiar, and see what you most wanted to learn. You might start with the IHI form and then try filling out the other two to see what additional elements you might consider. Call a few patients or families, or, if that is not appropriate, call the main attending physician in the community. Try to gain some insight from the perspectives of people involved.
Keep track of the time it takes to do this review.  If you can get someone to pull the charts, the work to this point will take about two or three hours. Of the time involved, what seemed most productive and what was most illuminating?

Then put together your own form, starting with whichever one is most suited and adding or deleting the elements to end up with the ones that you found to be most useful.  Test that form on another two or three records, perhaps asking a colleague to do those (to learn what instructions are needed and whether another perspective identifies other things that are very important to include.
My prediction would be that you’ll find some remarkable stories–people in fragile condition whose community doctors did not really know they were out of the hospital or doctors who were unfamiliar with the patient’s situation and medications; people who could not afford the treatment prescribed; and people who simply greatly misunderstood what they were to do. (I recall the patient who told me about having to eat fresh vegetables for his heart – whereupon he opened a fresh can of peas every day!) Those stories will greatly help you galvanize the will to move ahead.  And you’ll have a process and form that you can persuade the quality improvement team at each hospital to do: Perhaps at large hospitals, five each week for four weeks and at small hospitals, five in the month.  Within a month, you’d have enough data and stories to build the endeavor, and continuing to collect the data provides rapid feedback about progress. Pick a lead intervention or two and get it tested and underway!

You are likely to find a certain sense of chaos– that there is a lot of “catch as catch can” processing with thorough unreliability on all sides. If this is the case, your coalition might well work on standardizing the process simply so that it is reliable.  You may find that the issues affecting the frail elders are different from those affecting younger populations– more complexity and fragility in the elders and more lack of access or barriers arising from mental illness in the younger.  Whatever you find, this is the “root cause analysis” that you’ll need to decide priorities and to apply for CCTP funds.

Key words: root cause analysis, reviewing readmissions, discharge record review, quality improvement tools, CCTP funding

Print Friendly, PDF & Email
twitterrssyoutube

Better Care Transitions: Starting Points for Clinicians

 Posted by on July 29, 2011  No Responses »  Tagged with: , , ,
Jul 292011
 

As a frontline hospital or nursing home professional, you may be feeling increasingly frustrated with the lack of support, community follow-up and caregiver training for your vulnerable patients and residents. Despite your hard work these complicating factors are likely to send your patient or resident back to the hospital. Your administrators may have suggested to you that you focus on reducing readmissions and avoidable hospitalizations, or you may have caught wind of all the efforts underway to improve care transitions. Whatever has brought you here, you certainly have a sense that you need to get started now on ways of caring for your patients and residents differently.

Chances are, you are not in this alone, and others throughout your organization share your concerns—and have ideas for how to improve them. To learn more about what others are doing to fix care transitions and reduce transfer trauma, you might contact your state’s quality improvement organization, which is now charged with coordinating state and local endeavors to improve care transitions. You can find your state’s organization at: http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1144767874793  You might contact your Area Agency on Aging (for a national list, visit: http://www.n4a.org/about-n4a/?fa=aaa-title-VI) to learn more about its plans to respond to funding opportunities created by the Community-Based Care Transition Program (CCTP), also referred to as Section 3026 funding. If you haven’t already, you might reach out to your colleagues or peers in other local organizations, and find out what they’ve been doing, or what they plan to do.

Once you have a feel for what is going on in your own community, you might join forces with others who are motivated to make improvement happen.  You might find that a team already exists, or you might lead the formation of one. You will need someone—usually, several people—who are willing to embody the vision, take some risks, forge coalitions, and anchor the work. You may want to gather data about the experience of people using your community’s health care systems. You may want to gather stories—they are  a powerful way to communicate about experiences, to share ideas, and to learn from one another.

More than anything, start the process! Find something that you can do to get things underway. Try your ideas and learn from what works. Encourage others to join you—generate and build on their enthusiasm, and your own. Things may change slowly—but notice that they do.

Refer to the “Get Started” module on improving care transitions, now available online at www.medicaring.org. Based on the experiences of several organizations working to improve care, “Get Started” offers advice, guidance, and examples of how to build and sustain coalitions for this work, and how to measure progress. It is also full of real-life examples from other teams around the country. Build on their ideas and efforts as you develop your own. Be sure to check back often, as we plan to write frequently on issues surrounding care transitions, and on efforts to improve them. Or email us at [email protected]. We look forward to hearing from you.

 

Keywords: Care transitions, Section 3026, CCTP programs, avoidable hospitalizations, reduced readmissions

Print Friendly, PDF & Email
twitterrssyoutube

Details of LTQA Innovative Communities National Summit

 Posted by on July 25, 2011  No Responses »  Tagged with: , ,
Jul 252011
 

The Long-Term Quality Alliance (LTQA) was formed to respond to the increasing demand for long-term services and support and the expanding field of providers who are delivering that care. The Alliance is working to make sure that the 11 million people who need long-term services and supports in the United States receive the highest quality of care regardless of where that care is delivered. To that end, the LTQA  and its members are deeply interested in and committed to issues surrounding care transitions—improving those transitions as a way to improve patient experience, reduce medical errors, and make care more cost-effective.

At  the  recent  2nd Innovative Communities Summit, more than 130 participants engaged in presentations and dialogue focused on learning more about how to make care transitions safe, effective, and in the best interest of patients, residents, and their caregivers.  In opening remarks, Mary Naylor, Chair of the LTQA Board of Directors, described the local, community-based solutions that are necessary to respond to breakdowns in safety and quality. She noted that the field is looking for many things, including an opportunity to learn from other communities, especially around coalition- and community-building strategies; ways to raise awareness among communities about national programs now being launched; and strategies for advancing and sustaining the kinds of learning communities that will make such improvements a reality.

Other speakers included Kathy Greenlee, Assistant Secretary for Aging, and Paul McGann, Deputy Chief Medical Officer for CMS. A full report on the day’s presentations will be released soon, with highlights that include case studies of innovative communities, resources and insights from major national endeavors, strategies for community-building, and a perspective from the philanthropic community.

The LTQA is governed by a broad-based board comprised of 30 of the nation’s leading experts on long-term care related issues. The board has representation from consumers and family caregivers, providers, health service and researchers, evaluators and quality experts, private and public purchasers of care, foundations, think tanks, and agencies of the federal government that oversee aging issues and health care quality issues.

The LTQA works to make advancements in the quality of life of people receiving long-term services and supports by:

  • Facilitating dialogue and partnerships among all provider organizations that serve people needing long-term services and supports to help break down the provider silos in which quality initiatives have occurred.
  • Bringing consumers and family caregivers together with LTC providers and government agencies to agree on goals and associated measures of greatest concern.
  • Making stronger links between quality measurement goals and evidence-based practices to achieve them.
  • Collaborating with other quality improvement organizations on common priorities and goals.

We encourage you to learn more about LTQA’s work by visiting its website at www.ltqa.org, or by emailing me at [email protected].

 

Key words: care transitions, coalition building, innovative communities, quality improvement

Print Friendly, PDF & Email
twitterrssyoutube

Care Transitions Workbook

 Posted by on July 22, 2011  No Responses »  Tagged with: , , , , ,
Jul 222011
 

Community coalitions can be an effective way to engage diverse stakeholders in achieving common goals. Establishing such coalitions to address problems in care transitions is likely to be an essential tool for ensuring that such transitions become routinely good. Shortcomings in transitions today reflect larger, systemic problems that can best be addressed by community organizations working together. Indeed, no single organization will be able to resolve the broader issues, or work on its own to improve care transitions. It will truly take a village to make transitions safe, effective, and routine.

Many organizations around the country are looking to build coalitions that focus on care transitions. For many, similar experiences building community connections will enable them to establish and lead such coalitions. But many others will need guidance and support for learning the basics of coalition building, and for understanding issues specific to care transitions.

The Center for Eldercare and Advanced Illness posted a workbook, “It Takes a Village,” that offers  community leaders ideas and pointers for how to get started – and how to get going. It can be read in its entirety on the MediCaring.org website at: https://medicaring.org/action-guides/get-started

The guide provides an overview of coalition building, ranging from recruiting partners to resolving governance. It describes what to consider when setting priorities for the work. Much of the text is devoted to issues of measurement – how will coalitions know that their work is improving patient care and experience? The guide explains how to usemeasurement to advance the coalition’s goals, how to find good data sources, and how to decide on what to measure. It provides very specific information on fixing care transitions, including how to fix the hospital discharge process and how to target rehospitalizations. Because care transitions have a major effect on very sick and vulnerable patients and families, the guide also includes ideas for how coalitions can coordinate their efforts with palliative care programs and services.

Community coalitions have proven effective at addressing diverse public health issues, from improving maternal and child health to creating healthier environments. Coalitions are defined by their focus on a particular issue, by their willingness to collaborate, and by their ability to bring a range of resources and perspectives to problem-solving. The guide offers a starting point – we hope you find it compelling and useful.

We’d like to hear about your experiences – what works for you and what doesn’t, where are your successes and what have been your challenges. Please join the dialogue by offering comments here, or emailing us at [email protected]. We look forward to hearing from you!

 

Key Words: care transitions, rehospitalization, readmission, quality improvement, coalition building, data sources, measurement

Print Friendly, PDF & Email
twitterrssyoutube

Applying Ostrom’s Model to the Challenges of Health Care

 Posted by on July 15, 2011  No Responses »  Tagged with:
Jul 152011
 

Joanne Lynn and I have collaborated on a paper covering applications of Elinor Ostrom’s model of voluntary social arrangements to the challenges of Health Care. With this post we provide links where you can download our paper if you wish to read it in full.

Elinor Ostrom’s work to describe long-lived voluntary social arrangements that manage natural resources to optimize their use over time and prevent degradation through individual exploitation has been an important counterpoint to the previously dominant perception that successful management of limited natural resources depended upon having the resource owned by one private party or managed by strong government action.  The idea that the people who use the resource can manage it collectively has appealed to us and to others when addressing health care reforms.  However, there are obvious differences between health care delivery and harvesting fish or trees. This essay sets out to examine the similarities and differences, to state the analogies that might make health care similar to a common pool resource, and then to apply the main elements of Ostrom’s observations as to success or failure of institutions governing common pool resources to health care reform in the US.

You may download the full text of the paper either as a PDF file or as a Microsoft Word document.

Keywords: Elinor Ostrom, Ostrom’s model, health care reform in the United States, community based care, Jane Brock, Colorado Foundation for Medical Care, Medicare quality improvement program

Print Friendly, PDF & Email
twitterrssyoutube
 Older Entries  Newer Entries